SENSITIVITY AND PPV CALCULATION OF VA QUESTIONNAIRE USED TO DIAGNOSE CERTAIN COD

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SENSITIVITY AND PPV CALCULATION OF VA
QUESTIONNAIRE USED TO DIAGNOSE CERTAIN COD

• Sarimawar, Lamria, Yuana, Suhardi, S.Kosen,
  C.Rao, T.Adair
• NIHRD and Univ. of Queensland

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INTRODUCTION (1)

• IMRSSP IS AIMED TO DEVELOP THE COD REGISTRATION
  SYSTEM
• USING VA QUESTIONNAIRE FOR DEATH CASES AT HOME
• VALIDITY TEST OF SOME PREVALENT DISEASES AS UCOD
  FROM THE VA QUESTIONNAIRE
• THREE GROUPS OF VA 0-28DAYS, 29DAYS-BELOW 5 YRS,
  5 YEARS AND OVER
• VA QUESTIONNAIRE USED BY PARAMEDICS AND WELL
  TRAINED DOCTORS FROM PHC

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INTRODUCTION (2)

• THE EXPECTED RESULT IS TO FIND OUT WHETHER THE VA
  QUESTIONNAIRE IS ACCURATE AS AN INSTRUMENT TO
  DIAGNOSE THE UCOD BASED ON THE RELATED SIGNS AND
  SYMPTOMS
• THE DISEASES TRIALED ARE (18 DISEASES) PERINATAL
  CONDITIONS, BRONCHOPNEUMONIA, MATERNAL CONDITION,
  TBC, DIARRHOEA, DENGUE, MALIGNANT NEOPLASM OF GI
  TRACT, LUNG, BREAST, CERVIX, DM, IHD, HHD/CHF/DC,
  STROKE, PNEUMONIA, COPD, HEPATIC CIRRHOSIS,
  INJURY.

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METHODOLOGY (1)

• N SAMPLE 924 DEATH CASES 13 HOSPITALS IN JAKARTA
  AND SOLO
• 18 PREVALENT DISEASES SELECTED FROM MED RECORD,
  AND ARE REGARDED OF GOLD STANDARD
• THE IMRSSP INTERVIEWERS ASKING THE FAMILY OF THE
  DECEASED FOR SIGNS SYMPTOMS USING VA
  QUESTIONNAIRE
• REVIEWERS DETERMINE THE UCOD BASED ON ICD-10

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METHODOLOGY (2)

• TO DESCRIBE A DIAGNOSTIC TEST IS USED SENSITIVITY
  POSITIF PREDICTIVE VALUE (PPV)
• SENSITIVITY PROBABILITY OF X-DISEASE DIAGNOSED
  BY VA TOOL AMONG X-DISEASE DEATH CASES DIAGNOSED
  IN THE HOSPITAL (GS) FORMULA a/(ac)
• PPV THE PROBABILITY OF X-DISEASE DIAGNOSED BY
  HOSPITAL AS A GOLD STANDARD AMONG X-DISEASE DEATH
  CASES DIAGNOSE BY VA FORMULA a/(ab)

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METHODOLOGY (3)
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RESULT (1)

• OUT OF 924 DEATH CASES FROM MED.RECORD, 464 CASES
  VISITED INTERVIEWED COMPLETELY (50.8)

DISTRIBUTION OF DEATH CASES N (464) PERCENTAGE
lt 28 DAYS 35 7.5
29 DAYS-lt5 YEARS 24 5.2
5-14 YEARS 14 3.0
15-44 YEARS 73 15.7
45-54 YEARS 74 15.9
55 YEARS AND UP 244 52.6
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RESULT (2)

• THE DISEASES W/ HIGH SENSITIVITY (80)
  BRONCHOPNEUMONIA (NEONATAL), CA CERVIX
• MEDIUM SENSITIVITY (70-80) DIARRHOEA, DENGUE,
  CA OF LUNG, MATERNAL COMPLICATION, INJURY
• LOW SENSITIVITY (60-70) TB, CA OF GI TRACT, CA
  OF BREAST, STROKE
• VERY LOW SENSITIVITY (lt60) DM, IHD, CHF,
  PNEUMONIA, COPD, CIRRHOSIS HEPATIS.

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RESULT (3)

• THE DISEASES W/ HIGH SENSITIVITY AND HIGH PPV
  ARE
• CONDITIONS IN PERINATAL PERIOD
• BRONCHOPNEUMONIA IN NEONATAL
• DENGUE
• MATERNAL COMPLICATION

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LIMITATION

• HOSPITAL DIAGNOSES NOT FULLY GOLD STANDARD
  (DIFFICULT TO DETERMINE THE UCOD) E.C. UN
  CHRONOLOGICAL NARRATIONS, LACK OF DISTINCT
  INFORMATION ON PREVIOUS SYMPTOMS
• THE N OF SAMPLE OF SEVERAL DISEASES ARE TO SMALL

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CONCLUSION SUGGESTION

• EXTRA CARE SHOULD BE TAKEN WHEN INTERPRETING THE
  SENSITIVITY AND PPV TEST FOR CERTAIN COD DISEASES
  WITH ONLY TOO FEW SAMPLES OF CASES (lt20)
• THE MOH SHOULD DETERMINE THE RULES TO
  IMPLEMENTATE THE STANDARDIZED MORTALITY RR IN
  HOSPTAL

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THANK YOU